Lucy, whose name has been changed to protect her privacy, was 20 years old when she came for treatment in November 2012. She was tall, heavy-set, and shy as she came for treatment with adult acne. Lucy had many large, raised, cystic pimples on her forehead and cheeks.
“They come up all over my forehead and cheeks and about three or four months ago started to spread to my neck too. They’re always there! There hasn’t been a time in two years that my face hasn’t been covered. I’ve started noticing red scars on my cheeks, like little red craters after the pimples have gone.
They’re not just ugly, they hurt too. I feel them deep under my skin a few days before they come to the surface, then they’re really sore and filled with pus. I do pop them, I know I’m not supposed to, but I feel like it makes them go away sooner. I don’t like walking around with mountains of puss of my face; I’m afraid people with think I don’t wash.”
When asked about the initial onset, Lucy recalled that the outbreak started two years previously during college.
“They first started when I was in nursing school. I always thought I wanted to be a nurse but when I started the program I just felt bogged down with all the work. I worked so hard, afraid of failing my exams and labs, that I was exhausted. I’d spend hours studying for an exam, think I’d failed it, then end up getting an A, it was really stressful. I realized the program wasn’t for me, I was too stressed out all the time, so I changed programs.”
When questioned as to what had changed during the past few months, around the time the pimples had begun to spread to her neck and leave scars, Lucy said she has been under a lot of stress. With a little questioning Lucy described her stress as worry, a theme of that appeared to run through the case.
“I think I’ve always worried. Worried that I wouldn’t do well or be good enough – like with my driver’s license. I’m so afraid that I won’t pass the driving exam that I’ve never taken it, just keep renewing my learner’s permit. I worry a lot about my Mom. Even when I was younger I can remember worrying that something would happen to her, that she’d get sick and die. She’s had some health problems lately and I’m worried all the time that she’s really sick with cancer or something and the doctors just don’t see it.
I worry too what people think of me. I guess I don’t have much self-esteem. Growing up I always felt left out, excluded. It’s weird though, cause I’d be with people but felt like they didn’t really want me there, like I wasn’t good enough. I have lots of friends and like hanging out but sometimes I still feel lonely. I don’t know if I’ll ever find someone to love me. I think that’s one of my biggest fears, that I’ll be alone in life.”
Lucy’s worrying would also affect her sleep, making it difficult to fall asleep then toss and turn once she did.
“I have to watch T.V. to fall asleep, otherwise I won’t be able to. My mind just fills with thoughts, worrying mostly. Worrying about the day, about things I need to do, about the future, about my Mom. When I do get to sleep I toss and turn, waking up then falling back to sleep. I’m tired when I wake up but don’t like to sleep in. If I over sleep I feel kind of down, like I’ve wasted part of the day and part of my life.”
Lucy also admitted to having low self-esteem as long as she could remember. She was afraid to show people her true self, afraid that she “wouldn’t be good enough”. Lucy was also very affected by ridicule, humiliation, and being wronged by people. She would avoid people who had hurt or wronged her in any way, even felt uncomfortable talking about past situations of being hurt. Despite her lack of self-confidence Lucy was sociable and liked to be around other people, even though she often felt “lonely, even in a crowd.”
Other health issues Lucy was concerned about included asthma, frequent colds, and pre-menstrual complaints. Lucy had suffered from asthma since childhood and her symptoms had become manageable except when she was suffering from a cold or flu, which she fell ill with a few times each year. Each cold and flu Lucy contracted started with a sore throat. She recalled that she often had sore throats as a child, and was treated for strep throat and tonsillitis, along with many ear and sinus infections. Lucy had regular menstrual cycles that were accompanied by low mood, sadness, weeping, and irritability a few days prior to the start of menses.
With regards to general symptoms, Lucy was chilly and liked to be warm, could rarely be too warm. She preferred sunny, warm weather and thunderstorms, and didn’t like cold and rainy weather. She liked pasta, salty foods, cold drinks, and occasionally craved chocolate.
I repertorized the key symptoms of the case, using Lucy’s symptoms of worry, fear of failure, low self-esteem, acne, and tendency towards throat pain and chose the remedy Silica. This remedy best fit Lucy’s emotional symptoms regarding: lack of self-confidence, yielding nature, and fears of failure. It also represented many physical aspects of the case, including: acne leaving scars, colds that settle in the throat, lack of stamina, history of frequent ear infections, asthma, and general chilliness. A single dose of 30CH was given.
Follow-up, January 2013:
“I can’t believe how much better my acne is. I didn’t notice any changes at first but most of the pimples are gone now.”
Lucy’s face was much clearer, with only two pimples on her cheeks instead of the uncountable number from her initial consultation. She reported that “sometimes it feels like there are pimples under the skin but they don’t come to the surface and go away on their own.” Lucy was very pleased with the improvement in her acne but continued to be self-conscious about the red scars that remained.
With regards to worrying, Lucy stated that “it’s not quite as bad, maybe 10% improved.” The nature of her worry had shifted slightly though: “I’d fallen behind on my school work but am trying to catch-up. I’m nervous about what happens after I finish. I think that was making me procrastinate.”
When asked about any other changes during the past 6 weeks Lucy replied that her sleep had improved. “I’ve been working a lot during the last month and am tired in the evening. I’ve been falling asleep easier but don’t know if it’s because I’m so tired or not worrying.”
The remedy appeared to be working, as seen with the marked improvement in Lucy’s acne. At this time no action is to be taken but wait and follow-up again in six weeks.
Follow-up, March 2013:
Lucy’s acne remained improved. At the time of the visit she had three pimples in total and reports usually having 1-3 pimples always present. The redness in her scars had also diminished slightly.
Lucy reported that her worrying had improved as well.
“I don’t worry about everything and anything anymore. Now it’s more about certain people and situations. Like, there’s a guy at church I really like and we’ve been chatting a bit. I think later about our conversations and worry how I came across. I don’t have the confidence yet to just go over and talk to him, I’m nervous about what he’ll think.”
During out initial consultation Lucy had expressed how her fear of failure prevented her from doing things, such as getting her driver’s licence.
“I got my driver’s licence. I finally decided to take the test. I failed it the first time and thought I wouldn’t go back to do it again, I was so embarrassed. Then some co-workers told me stories about how they didn’t pass the first time either. I booked to take the test again, but didn’t tell everyone in case I failed again, and I passed!”
Lucy reported that she was less worried about her mother’s health despite no changes in her health. In the past she had been afraid her mother would become seriously ill and die, she realized that these were unfounded fears. Lucy’s father had been ill and in the hospital for a short time since her last visit.
“My family and I were surprised how well I handled it [her father’s illness]. I thought I would be more upset and worried than I was. Usually I’d be afraid that the doctors missed something and think the worst would happen. Instead I kind of trusted them when they said he’d be okay.”
The remedy was continuing to work and show signs of improvement with Lucy. The improvement in her acne from the previous appointment continued along with diminishing appearance of the scarring. Lucy also began to see improvements with her worries, as seen with her reaction to her father being ill, and her courage to take her driver’s test despite fear of failure. At this time no action should be taken but to wait and follow-up again in 6 weeks.
Follow-up, May 2013:
“I messaged the guy from my church, the one I told you about last time. I was nervous but took the initiative and actually messaged him.We’ve been dating for a few weeks now. He’s shy and nervous like me. I thought he wasn’t interested in me, thought that I wasn’t good enough,then I found out that he was just too shy to ask me out first.”
This was a marked improvement in Lucy’s confidence. When asked about worries now she replied:
“I don’t worry as much as I used to or about the same stuff. Now if I worry it’s just about little things of my relationship. I’ve never had a boyfriend before so it’s all kind of new.”
Lucy then embarked on a lengthy description of the “little things” in her relationship that worried her, such as: “We haven’t kissed yet though, is that normal? I don’t know if he is too shy to kiss me or if he doesn’t want to kiss me. I don’t know if I should kiss him first or wait?” Although Lucy stated that she worried less, the focus of the worry seemed to be centered on her insecurity. The confidence from only minutes earlier when talking about taking the first steps in the relationship was replaced by a flood of worry and doubts. Lucy had taken a big step forward in initiating the relationship after weeks of contemplating it. While this was a significant step forward her worrying continued, shifting focus to her relationship.
When asked about any other changes Lucy stated:
“My pimples haven’t really changed much. I still get a few occasionally on my cheeks or forehead. The scars are still there. They’ve faded a bit more but not all the way yet. My sleep is better. I’m actually waking up with energy and not having to press the snooze button. I’ve started going to the gym, which makes me feel like I have more energy too. I’ve started eating healthier and drinking water more regularly.”
Lucy had improved on some levels: energy, overall feeling of health, and the courage to initiate contact with the object of her affections. However, her worrying had shifted focus and appeared to be centered on her insecurity and lack of self-confidence. There had also been a stall in the improvement of the acne symptoms, with no significant changes in months. The remedy Silica 30C was repeated, followed by a dose of Silica 200C the next day.
Four weeks later I bumped into Lucy. She said she was feeling great, and had clear skin for weeks. She told me about changing jobs to one that would be more applicable to her studies and was enjoying a new role with more responsibilities. She told me she was still in her relationship and things were great. Lucy felt that she did not need to return for another appointment at that time. At a chance encounter months later Lucy was still feeling great and sporting a clear complexion.